AccountId: 011433970860
ContactId: d477277b-f56b-4fa8-931f-4b23f5bbce41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419619 ms
Total Talk Time (AGENT): 93201 ms
Total Talk Time (CUSTOMER): 203081 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/d477277b-f56b-4fa8-931f-4b23f5bbce41_20250625T14:44_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello my name
[CUSTOMER][NEUTRAL] Hello, my name is [PII] calling from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm good, how are you?
[CUSTOMER][POSITIVE] Yeah, I'm also doing good.
[AGENT][NEUTRAL] How can I assist?
[CUSTOMER][NEUTRAL] Mm, actually I want to know about the claim status, so could you help me for that?
[AGENT][POSITIVE] I'd be happy to assist with claim status if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII] with the extension of [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 663101743.
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] Yeah, it's H 63101743.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Do you have a social?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] That is not one of our policy numbers. Do you have a social security number I can look up?
[CUSTOMER][NEUTRAL] No, I don't have.
[AGENT][NEUTRAL] What's the patient's name?
[CUSTOMER][NEUTRAL] It's [PII], sorry, [PII].
[AGENT][NEUTRAL] Spell that for me.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Can you spell the name for me please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, we don't have anyone in our system by that name.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So this is not in your system.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Or but.
[CUSTOMER][NEGATIVE] But uh as I can see in my system, this claim is denied.
[CUSTOMER][NEUTRAL] Uh, for PCP referral.
[AGENT][NEGATIVE] That's not us. That sounds like that's a major medical denial and also that's not our policy number and that person's name is not in our system. So, um, I think you're calling the wrong company.
[CUSTOMER][NEUTRAL] It's Humana.
[AGENT][NEUTRAL] We're not Humana. We're American Public Life. We're APL, American Public Life, we're not Humana.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh sorry, yeah, I took it wrong. Uh, yeah, so I have the claim and uh I want to discuss on that. Uh, so could you help me for that?
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Yeah, so I do have the policy number that is 02298031.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] And the date of service for the claim?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the tax ID.
[CUSTOMER][NEUTRAL] Uh, so tax ID is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so I'm showing a payment was made in the amount of $17.08 on this claim.
[CUSTOMER][NEUTRAL] Uh yeah, so payment is done, uh.
[AGENT][NEUTRAL] And that was
[CUSTOMER][NEUTRAL] Through American Public Life Insurance, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, of $17.08 correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, uh, so I want to ask about the dollar 19.1 for uh amount. So could you help me for that?
[CUSTOMER][NEUTRAL] Uh, is this paid by American Public Life Insurance?
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] I'm confused. I, I don't know what you're asking me.
[CUSTOMER][NEUTRAL] Yeah, yeah, let, let me, uh, let me solve this, uh, so you said that.
[CUSTOMER][NEUTRAL] Actually, UHC that is United Healthcare, uh, processed, uh, deductible of 36.22 uh and the
[CUSTOMER][NEUTRAL] The $17.08 paid by American Public Life Insurance, right? The remaining amount, yeah, the remaining amount of $19.14 applied towards the deductible. So I'm asking that, uh, is this paid by American Public Life Insurance or not?
[AGENT][NEUTRAL] No, we pay what we're gonna pay the $17.03 and 8 cents.
[CUSTOMER][NEUTRAL] OK, so that means this is the patient's responsibility, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Uh, so I want to ask that, uh, uh, there is any, uh, another insurance?
[AGENT][NEUTRAL] That is a question for the insured.
[AGENT][NEUTRAL] You'll have to contact the insured to ask them if they have any other insurance.
[CUSTOMER][NEUTRAL] OK, no issue, and uh can you provide me the claim number for this?
[AGENT][NEUTRAL] 359-1995
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] This is for this OK and may I have your caller reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Uh, no, thank you for your assistance and have a good day. Enjoy your day. Yeah, you, you too, bye.
[AGENT][POSITIVE] Thank you for calling APO have a good day.